Wound Management: Assessment, Evaluation, Healing, Factors, and Pain Management

Wound management
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1.Holistic assessment of the patient.
a) Presenting problems
The patient presents with a poor oral intake. There is also pain that is located in his wounds
of the diabetic foot and an arterial artery.
b) Past medical history
The patient has been diagnosed with chronic obstructive pulmonary disease. The patient also
reports being having postural hypotension, type 2 diabetes mellitus, gastroesophageal reflux
disease which is managed accordingly. The patient also has an ethanol addiction.
c) Social history
He lives in his retirement home village alone. His wife passed away one year ago.
d) Nutrition and elimination
The patient has a poor oral intake and mostly takes soft drinks. The patient has stool
incontinence as evidenced by a pad in situ.
e) Medications
The patient is on furosemide 20mg which he takes orally twice a day, Endone 10mg thrice a
day, Hydromorphone 2mg twice a day, Telmisartan 40mg twice a day, Ventolin 4 puffs thrice
a day, Esomeprazole 20mg daily, warfarin 2mg daily and Lantus 20 units when necessary.
f) Cognitive function
The patient is confused at times.
Types of wounds
A) A diabetic ulcer is an open sore that occurs as a complication of diabetes mellitus and
mostly occurs in the lower extremities (Yazdanpanah, Nasiri, & Adarvishi, 2015). It
can be also due to compromised circulation, trauma, friction or pressure to toes.
B) A pressure ulcer is an injury to the skin and the tissues underlying that occur due to
prolonged pressure on the skin. (Bhattacharya, & Mishra, 2015)
C) An arterial ulcer comes about when there is poor circulation to the lower extremities
leading to poor perfusion causing an open wound.

D) A burn is an injury to the skin and other tissues of the body. They can be caused by
electricity, chemicals or even radiation.
Investigations for wound assessment
a) Complete blood count to check for elevated white blood cell count that indicates the
presence of an infection.
b) A biopsy can be taken in the case of an arterial ulcer to check for malignancy.
Wound management principles
Cleaning and dressing using the right dressing material should be done on a regular basis.
The treatment of the underlying cause of the wound like chronic illnesses like diabetes and
hypertension or even controlling.
Pain management should be key prior to cleaning.
2. Evaluation of each type of wound
Pressure ulcer. Being a stage three type of wound, there is a full thickness loss of skin. The
bone below is not be exposed through the fat will be seen. The skin surrounding the sore is
intact. There is a 30% tissue granulation.
An arterial ulcer that is infected. The wound has a smelly odor. It has a well-defined margin.
The surrounding of the wound is pale and shiny. There is no hair and the wound is not
bleeding. Arteriography or arterial Doppler studies can be done for further assessment.
Burns wound. There are blisters on evaluation and is irregular in the pattern. The skin is red
in color. The skin surrounding the wound is intact and there is no bleeding of the wound
noted and no odour was noted.
The diabetic foot ulcer that looks infected with an odour, measures about 2-3 centimeters and
is green in color.
3. Wound healing processes
Pressure sore. The healing rate is different for each type of sore. For the third stage of the
pressure sore, it heals by forming a scar. Since the patient has a poor oral intake, the healing